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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG214PPR Printed: 2/5/2003 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />License Number: A- 01474 -003 <br />Effective Date: 9/1/2001 Expiration Date: 8/31/2003 <br />Name of Organization: Lake Owasso Residence Volunteer Council <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />Market Place Center <br />2900 Rice St <br />Little Canada, MN 55113 <br />County: Ramsey <br />Note: Our records show the premises <br />is located within the city limits <br />Name of the property owner (If different): <br />Lessor Information <br />Square footage leased per month: <br />Rent paid per month: <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br />Bingo Activity <br />Our records indicate that Bingo is conducted on these premises. Please refer to the instructions for required at <br />Storage Information <br />465 E Little Canada Rd <br />Little Canada, MN 55117 <br />US Bank of Little Canada <br />2850 Rice St <br />Little Canada, MN 55113 <br />Bank Information <br />Gambling Bank <br />Account Number: 105115147321 <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and <br />withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br />Name <br />Address City, State, Zip Code <br />Title <br />Jane Louise Sybrandt <br />235 Jansa St <br />Shoreview, MN 55126 <br />7/iA7/ 2/0 <br />Pamela Thompson <br />2275 Rice St <br />Roseville, MN 55113 <br />Betty Marie Strohbeen <br />465 E Little Canada Rd <br />Little Canada, MN 55117 �.�,J <br />6 Q / l ? p <br />(Be sure to complete the reverse side of this application) <br />This form will be made available in alternative format lie. large print, braille) upon request. Page 1 of 2 (Continued on Back) <br />